How can you play your part in accountability?
Nurse play a significant role in the quest to provide accountable care. Since nurses are at the frontline of the care provision, they have direct influence on the quality of services being provided and the use of resources when a patient is undergoing treatment. Firstly, nurses will help address the challenge of shortages in primary care providers that affect the quality of healthcare received by millions of Americans ( Nickitas, Middaugh, &Aries, 2016) . In addition, accountability can also be achieved if I work collaboratively with other experts to ensure that the care provided to my patients is value based. The main premise of ACO is coordination, and since nurses interact with patients more frequently when compared to other healthcare practitioners, they are a vital cog in the ACO machinery. They connect physicians, patients, and their families, ensuring that they are in sync during the care process. By ensuring that the care is patient-centered, the nurses play a critical role in giving patients the care they need. In the conventional systems, patients can be subjected to unnecessary tests and treatment procedures to bump up the hospital’s revenue ( Bard & Nugent, 2011) . However, being accountable means that a nurse should be preoccupied only with the needs of the patient, and since the ACO system empowers nurses to make such decisions and to coordinate with other care givers on the same, patients are able to enjoy care that is suited for their needs.
Briefly define the Accountability Care Organization
An accountable care organization (ACO) refers to a group of hospitals, doctors and other medical practitioners who work in tandem to provide care. The main aim of such collaborations is to provide enhanced and coordinated treatment to patients. When experts with different skills work together, it is likely that the patient will receive the care he or she needs ( ( Bard & Nugent, 2011 ) . It also reduces the chances of miscommunication and errors during the treatment process, ensuring quick recovery times for patients. Furthermore, it reduces healthcare costs, since a patient does not have to undergo expensive and unnecessary treatments or tests ( Nickitas, Middaugh, &Aries, 2016). The value of ACO is most apparent in cases where a patient suffers from chronic illnesses such as diabetes, high blood pressure, and cancer among others. Based on the benefits of ACO, it not only ensures that the patients receive high quality care, but also makes prudent use of resources which can be redirected to improve other aspects of healthcare.
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What challenges do we face?
Even though ACO is beneficial for patients and the healthcare sector in general, it has several drawbacks. One of the challenges is the perverse payment model in the U.S. The current system rewards the volume of healthcare service offered to the patient. Therefore, the more procedures a patient undergoes, the more the revenue generated for the institution. For many organizations, the prospect of moving towards an evidence based reimbursement system is unappealing since it has a direct impact on their revenue. In the short term, many providers are keen to provide more efficient and effective care to increase their revenue (Pearl, 2014). Even though they concede that there are flaws in the current mode of operation, they are fearful that high overhead and fixed costs will not allow the institutions to sustain the reduction of income in the long term. In this context, the organizations battle between what is good for the patient versus their bottom line.
Another challenge is that hospitals might have the wrong staff numbers. The number of doctors and specialists is random in most institutions. For example, an institution might have 4 orthopedic surgeons and 6 physiotherapists. However, after the redesign, the institution might require four of each to serve the patients effectively under the ACO system. In addition, when a specialist is excluded since his or her services are deemed to be surplus, the experts might decide to move their patient’s to other hospitals affecting the bottom line (Pearl, 2014). If an institution loses patients, then the efforts to reduce costs while improving the quality of care will be hampered. Therefore, ACOs are forced to retain their staff, even if restructuring is required, negating the efforts to make care more streamlined and efficient.
Technology is an important requirement in the success of ACOs. Currently, physicians use different EHRs, and in some cases, they are different from the systems used in hospitals. Therefore, getting the experts in an organization to work together is not as easy as it appears on face value. The major technical challenges need to be addressed to ensure that the systems being used are compatible to facilitate the smooth exchange of information ( Bard & Nugent, 2011 ) . If such systems are not in place and there is a communication breakdown, there is a high chance that a patient might receive redundant care or errors might occur during the care process.
The final challenge is that ACOs do not have a well-defined physician structure of leadership due to its model. The source of investment in ACOs are hospital partners who generate investment and new facilities to improve care. However, if there is no CEO, it is difficult to make the changes required to utilize these resources in a manner that benefits the patients. Hospital administrators have to embrace physicians as equal leaders in the system for it to work effectively (King et al., 2014). Under the current system, the bottom line is the main focus, meaning that an institution can operate with involving physicians in the administrative process. This is not the case in ACOs, since the focus is on quality care as opposed to volume of care.
How do you see the role of the healthcare worker changing as a result of these challenges?
As mentioned earlier, it is important for both the organization and healthcare professionals to change for the ACO model to work. Under the traditional or conventional system, the focus is on the bottom line, even though there are deliberate efforts to improve the quality of care. Therefore, the roles of the healthcare professionals have to change significantly for the goals of a value based system practiced in ACOs to be actualized. The need to provide tailored care solutions for the patient means that the conventional roles of the healthcare professionals involved needs to be expanded (Gady & Families United for Senior Action Foundation, 2012). One way that this can be achieved is encouraging the healthcare providers e to take up leadership roles in the organization, since they play a direct role not only on enhancing the quality of care, but also on ensuring that the available resources are utilized adequately.
In addition, the healthcare professionals become care coordinators in the ACO system (King et al., 2014). Being part of an inter-professional team means that coordination of care is crucial for the success of ACOs. Therefore, the professionals will have to be care coordinators on a larger scale. Furthermore, since quality is the main focus in ACOs, the healthcare workers have to embrace the role of quality improvement managers through the promotion of evidence based care. Utilizing the data shared in the network, the healthcare workers will have to come up with innovative solutions to give the patients the best possible care outcome. They will also have to play the role of communicators (Gady & Families United for Senior Action Foundation, 2012). As mentioned earlier, communication is imperative in a system that requires the collaboration of different experts. They need to translate the treatment plans and care choices at different levels of care to ensure that there is no miscommunication or misinterpretation. It is clear that the healthcare professionals have to take up multiple roles in order for them to fit into the new system and enhance the quality of care and the healthcare outcomes for patients, particularly those with chronic ailments.
References
Nickitas, D.M., Middaugh, D.J., &Aries, N. (2016). Policy and politic for nurses and other health proffessions (2nd Ed)
Pearl, R. (2014, Aug 14). The 4 Biggest Obstacles ACOs Face. Forbes . https://www.forbes.com/sites/robertpearl/2014/08/14/the-4-biggest-obstacles-acos-face/#2e675a4265f2
Bard, M., & Nugent, M. (2011). Accountable care organizations: Your guide to design, strategy, and implementation . Chicago, Ill: Health Administration Press.
Gady, M., & Families United for Senior Action Foundation. (2012). Putting the accountability in Accountable Care Organizations: Payment and quality measurements . Washington, D.C: Families USA.
King, R. C., Rose, R. V., Merritt, M. R., Okray, J., & American Bar Association. (2014). The ABCs of ACOs: A practical handbook on accountable care organizations . Chicago, Illinois : ABA, Health Law Section
